[Management of dysmenorrhea]. / Prise en charge des dysménorrhées.

Dysmenorrhea is one of the most common reasons for consultation in gynecology. The social and economic burdens are important. Dysmenorrhea may therefore be considered as a major public health issue. Its management is not yet optimal as dysmenorrhea still affects the quality of life of many patients. Primary dysmenorrhea, with no underlying organic cause, results from myometrial hyper contractility, arteriolar vasoconstriction, and tissue hypoxia. Secondary dysmenorrhea may involve the pathophysiological mechanisms of primary dysmenorrhea, but is mainly the expression of an underlying gynecological pathology. Although the pathophysiology of primary dysmenorrhea is well established, studies are now focusing on treatments to improve the management of these patients, who are often young. Nonsteroidal anti-inflammatory drugs and oral contraception remain the recommended firstline drugs, but their effectiveness can be enhanced by complementary therapy such as local heat application or regular exercise. Studies on other unconventional complementary therapies, such as ginger consumption, are very encouraging and need to be reinforced to incorporate recommendations for the management of primary dysmenorrhea.

Les dysménorrhées représentent un des motifs de consultation les plus fréquents en gynécologie. Les répercussions sociales et économiques qu'elles engendrent en font un phénomène de santé publique. Leur prise en charge n'est pas encore optimale et les dysménorrhées altèrent toujours la qualité de vie de nombreuses patientes. Les dysménorrhées primaires, sans cause organique sous-jacente, sont le résultat d'une hyper contractilité myométriale, d'une vasoconstriction artériolaire et d'une hypoxie tissulaire. Les dysménorrhées secondaires peuvent faire intervenir les mécanismes physiopathologiques des dysménorrhées primaires mais sont surtout l'expression d'une pathologie gynécologique sous-jacente. Si la physiopathologie des dysménorrhées primaires est de mieux en mieux connue, les études s'intéressent à présent aux options thérapeutiques pour améliorer la prise en charge de ces patientes souvent jeunes. Les antiinflammatoires non stéroïdiens et la contraception orale restent les molécules recommandées en première intention mais leur efficacité peut être potentialisée par des traitements complémentaires comme l'application locale de chaleur ou la pratique régulière d'exercices physiques. Des premiers résultats concernant d'autres thérapies complémentaires non conventionnelles, comme la consommation de gingembre, sont très encourageants et doivent être renforcés pour intégrer les recommandations de la prise en charge des dysménorrhées primaires.

[Simulation training in the management of obstetric emergencies. A review of the literature]. / L'intérêt de la simulation dans l'apprentissage de la prise en charge des urgences obstétricales. Revue de la littérature.

UNLABELLED: To assess the value of simulation based training in the management of obstetric emergencies. METHOD: A search by keywords: obstetrics, gynecology, simulation, drills, emergency training restricted to randomized trials led to a selection of eight articles. RESULTS: Shoulder dystocia simulation unmasked deficiencies in performing Mc Robert maneuver in nearly 20% of doctors in training as well as ineffective and potentially harmful maneuver such as pressure on the uterine fundus. Delivery of the impacted shoulder improved from 42.9% to 83.3% after simulation training leading to a shorter head to body delivery interval. In postpartum haemorrhage simulation, lack of knowledge on prostaglandins and alkaloids of ergot, delay to transfer the patient to the operating room (82% of cases) and a poor communication between different professionals were identified. Post simulation improvement was seen in knowledge, technical skills, team spirit and structured communication. In severe preeclampsia simulation, mistakes such as injection of undiluted magnesium sulphate, caesarean section on an unstable patient were identified and reduced by 75%. Management of magnesium sulphate toxicity was also improved after simulation training. CONCLUSION: This review confirms the potential of simulation in training health professionals on management of obstetrics emergencies. Although the integration of this training modality into the curriculum of health care professionals in obstetrics and gynaecology seems beneficial, questions on the cost, the minimum standard of facilities, type of mannequins, human resources and frequency of drills required to achieve the learning objectives remain unanswered.

Management of recurrent vault prolapse.

In the ageing female population, recurrent vaginal vault prolapse is a significant healthcare burden. There is limited evidence regarding the optimal management strategy for recurrent vault prolapse. This paper aims to discuss treatment modalities available for recurrent vault prolapse. A literature search and analysis was performed using Medline, PubMed, Cochrane database, current texts and references from relevant articles. We found inconclusive evidence supporting conservative, mechanical and some surgical options for treating recurrent vault prolapse; including iliococcygeal fixation, McCall culdoplasty, and infracoccygeal sacropexy. Sacrospinous ligament fixation (SSLF), sacrocolpopexy, mesh implants and colpocleisis are shown to have good outcomes in Level II studies. Nevertheless, the first two are associated with haemorrhage, dyspareunia and scarring whilst colpocleisis is limited to selected patients. More well-designed studies are required for recurrent vault prolapse. Current evidence suggests SSLF, and sacrocolpopexy are alternative surgical options to colpocleisis in treating recurrent vault prolapse. Randomised trials are required to determine the efficacy and safety of trocar-guided mesh kits.